Favorable Early-Stage Hodgkin Lymphoma

Abstract

The category of favorable early-stage Hodgkin lymphoma (HL) includes patients with Ann Arbor stages I or II disease with no bulky disease or B symptoms. The precise definition of favorable versus unfavorable early-stage disease may vary among American and European cooperative groups. The overall 10-year survival rate of patients with favorable early-stage HL exceeds 90%. Indeed, effective treatments for this group of patients have been available for more than 4 decades. However, treatment strategies have radically changed over the past 15 years and focus now on maintaining the high cure rate while reducing the risk of treatment-related long-term morbidity. The optimal treatment is still evolving, and more recently, reduction in the total amount of chemotherapy and in radiation field and dose has shown excellent results. Combined modality therapy is the preferred treatment for patients with classical favorable early-stage HL (nodular sclerosis or mixed cellularity histology). Patients with early-stage lymphocyte predominance HL are highly curable using involved-field radiation therapy (IFRT) alone and do not require chemotherapy. Classical favorable HL is also curable with radiotherapy alone or with chemotherapy alone, but larger fields and higher-dose radiation or longer chemotherapy is required compared with combined modality. The freedom from treatment failure rate is significantly better with a combination of short chemotherapy and IFRT than with either chemotherapy or radiotherapy alone. Although combined modality is the standard preferred treatment for favorable disease, radiation therapy alone or chemotherapy alone could be considered under special circumstances or as part of an investigational protocol.

CD163 Expression Was Associated with Angiogenesis and Shortened Survival in Patients with Uniformly Treated Classical Hodgkin Lymphoma

“…In fact, TAMs contribute to extracellular matrix remodeling, promote cancer cell proliferation, invasion and metastasis; suppress the adaptive immune response [25], [40]. Secondly, VEGF-positive patients are more likely to have the NS or MC disease subtypes, which are associated with a better overall prognosis than other cHL subtypes [44], whereas CD163 expression did not show any such predilection. Thirdly, the relatively small size of the present cohort may preclude the power needed to fully demonstrate the effect of increased TAMs, thereby limiting the interpretation of the present results and calling for further validation.…”

Prognostic Significance of COX-2 Expression and Correlation With Bcl-2 and VEGF Expression, Microvessel Density, and Clinical Variables in Classical Hodgkin Lymphoma

“…The reason for this discrepancy is not clear, but several explanations are possible. 43 This difference in subtype frequency may result in different survival outcomes between COX-2-positive and VEGF-positive subgroups. In particular, patients with COX-2 positivity had a trend toward increasing Bcl-2 positivity (15.2% vs. 5.8%), and Bcl-2 positivity had a trend toward a worse OS (5-y OS rate, 65.8% vs. 84%), but neither difference was statistically significant.…”

Does radiotherapy still have a place in Hodgkin lymphoma?

“…About two thirds of women with early-stage HD do not require radiation of the axillae, however, and additional protection to the upper and medial aspects of the breast can now be provided by further reducing fi eld size using careful CT-based planning, which usually allows for smaller mediastinal volumes, particularly after chemotherapy. We can now avoid irradiating the breast in most women and substantially reduce exposure of the heart and lungs [15]. A recent assessment of individualized risk demonstrated that fi eld and dose reductions of the mantle fi eld substantially reduce the expected risk of breast and lung cancers [16•].…”